Lymph duct cannulation facilitator

ABSTRACT

A device is provided to facilitate lymph duct cannulation. An enclosed chamber having a pair of pliable membranes surrounds a portion of the duct. The chamber pressure is reduced to aid dilation of the duct as excess lymph is massaged into the enclosed duct region. The cannulation needle is guided into the dilated duct via an end opening in the chamber.

United States Patent [191 Tech [ LYMPH DUCT CANNULATION FACILITATOR [76] Inventor: Herbert Toch, 15847 E. Arbella Drive, Whittier, Calif. 90603 221 Filed: Jan. 2, 1914 [21] Appl. No.: 429,747

52 us. or. ..128/2A;128/213 51 Int. cl. ..A61B 6/00 [58] Field of Search 128/2 R, 2 M, 2 A, 334 R, 128/334 C, 346, 327, 214 R, 321, 128/DIG. 26. 213

[56] References Cited UNITED STATES PATENTS 2,452,799 1 H1948 Speaker at al 128/2.05 V 3,361,133 1/1968 Kimberley et al. 128/346 3,368,550 2/1968 Glascock 128/2 A 3,526,481 9/1970 Rubricus 128/2 R X 1 Nov.4, 1975 3,561,448 2/1971 Peternel... 128/346 X 3,786,817 1/1974 Palma 128/334 R 3,814,080 6/1974 Norman 128/346 X OTHER PUBLICATIONS Tegtmeyer, C. J., Brit. Journ. of Radiology, 46, p. 143-144, Feb. 1973.

Primary Examiner-Kyle L. Howell Attorney, Agent, or Firm-Howard A. Silber [57] ABSTRACT A device is provided to facilitate lymph duct cannulation. An enclosed chamber having a pair of pliable membranes surrounds a portion of the duct. The chamber pressure is reduced to aid dilation of the duct as excess lymph is massaged into the enclosed duct region. The cannulation needle is guided into the dilated duct via an end opening in the chamber.

4 Claims, 5 Drawing Figures DIST.

U.S. Patent Nov. 4, 1975 DlSTAL A vacuum PROXIMHL PRESSURE VACUUM LYMPH DUCT CANNULATION FACILITATOR BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to apparatus for facilitating lymph duct cannulation.

2. Description of the Prior Art Medical x-ray study of the human lymphatic system (lymphography) involves the injection of an x-ray opaque material into a lymphatic vessel. The opaque material, typically an oily contrast material containing iodine, is injected into the lymph duct via a needle or cannulator of small size, typically 27 or 30 gauge. Insertion of the cannulation needle is difficult, owing to the very small diameter, typically about 0.1 to 0.4 millime ter, of the lymph duct.

The conventional lymph duct cannulation procedure is described in the textbook Technique of Lymphography and Principles of Interpretation by Hans Kuisk, M.D., published in 1971 by Warren H. Green, Inc. As described therein, the cannulation procedure involves an initial injection of an indicator dye into the site of the lymphatic system being investigated. For example, the injection of a blue dye into the tow webs will permit visualization of the cutaneous lymphatic trunks near the top of the foot. This serves as a guide for making an incision (FIG. 1) into the subcutaneous region of the foot 11. A lymphatic trunk 12 (FIG. 2) is isolated and lifted up from the adjacent gelatinous subcutaneous tissue 13.

The next step is to dilate the isolated vessel 12 sufficiently so that the needle can be inserted. In the conventional double thread method, two fine (4-0) silk threads are placed under the vessel 12 and the upper (proximal) thread carefully tightened around the vessel to form a flow obstruction. The injection (distal) side now is massaged until the vessel fills with blue lymph and exhibits a characteristic knobby appearance.

When the vessel is maximally distended, the needle is inserted from the distal end, care being taken to insure that the tip of the needle is situated in the lumen or passageway of the duct. The proximal thread then is loosened, slipped down, and tied around the needle tip. The distal thread is knotted about the lymph duct to limit flow of the injected material in the distal direction. The x-ray opaque material then is injected via the cannulated needle and flows through the lymph duct 12 in the proximal direction. Roentgenograms then are taken. The injected lymphatic vessels stand out clearly and can easily be studied on the resultant x-rays.

The cannulation procedure just described is difficult owing to the very small size of the lymph duct 12. The tasks of isolating and dilating the lymph duct, and of inserting the needle into the lumen, are exacting and tedious. Aids to facilitate such cannulation are needed.

One such aid which is commercially available is described in the article entitled A New Lymph-Duct Cannulator by Charles J. Teghtmeyer, M.D., in the February, 1973 issue of the British Journal of Radiology, Volume 46, pages 143-144. The Teghtmeyer cannulator utilizes a three-piece interlocking plastic structure to perform the functions of duct blockage during dilation and guidance of the needle into the duct. The central component of the Teghtmeyer cannulator is a lymph duct holder which includes an axial groove into which the lymph duct is placed. The second member of the cannulator is a lymph duct occluder which is matingly inserted at the proximal end of the central lymph duct holder to clamp off the duct during dilation. The third member is a needle inserter which is connected to the distal end of the central lymph duct holder subsequent to dilation. The inserter includes a needle guide hole aligned with the axial groove in the holder. The needle is guided through the inserter directly into the lumen of the duct. The occluder member then is removed and the iodine-containing oil is injected through the needle, which remains situated in the inserter during the injection procedure.

The object of the present invention is to provide an improved aid for facilitating lymph cannulation. Such facilitator includes a device for distending the lymph duct by reducing the pressure exterior thereof.

SUMMARY OF THE INVENTION This and other objectives are achieved by providing a cannulation facilitation tool which aids dilation of the lymph duct, and hence ameliorates the difficulty of inserting the needle into the lumen. The facilitator disclosed herein includes a closed chamber emplaced about the isolated duct. Within the chamber is pliable rubber or plastic membrane. A slight positive pressure is utilized within the chamber to squeeze out the air from between the membrane and the lymph duct. A slight vacuum then is drawn in the chamber. The resultant reduced pressure exterior of the lymph duct aids dilation thereof. The cannulation needle then readily may be inserted into the dilated duct through an axial end opening of the chamber.

BRIEF DESCRIPTION OF THE DRAWINGS A detailed description of the invention will be made with reference to the accompanying drawings wherein like numerals designate corresponding elements in the several figures.

FIG. 1 shows the location of a typical incision cite for cannulation of lymphatic trunks in the dorsum of the foot.

FIG. 2 is an enlarged view of the incision shown in FIG. I, with a lymph duct isolated prior to cannulation.

FIG. 3 is a greatly enlarged pictorial view. partly broken away and in section, of a cannulation facilitator providing a reduced pressure condition exterior of the lymph duct.

FIGS. 4 and 5 are transverse sectional views of the device of FIG. 3, as seen along the line 4-4 thereof, FIG. 5 illustrating distention of the lymph duct under mild vacuum conditions in the device.

DESCRIPTION OF THE PREFERRED EMBODIMENTS The following detailed description is of the best presently contemplated mode of carrying out the invention. This description is not to be taken in a limiting sense, but is made merely for the purpose of illustrating the general principles of the invention since the scope of the invention best is defined by the appended claims.

The cannulation facilitator 15 (FIG. 3) aids dilation of the lymph duct 12 by providing a slight vacuum exterior thereof. The facilitator 15 comprises two identical, generally semicylindrical members 15a, 15b each having a rigid exterior shell 16 closed at both ends 16a, 16b. peripheral seal 17 of resilient plastic material extends around the entire lip or edge 18 of each shell member 16. Each end portion 16a, 16b is centrally re cessed so that when assembled as shown in FIG. 3 there 3 exists a pair of end coaxial openings 19, surrounded by a portion 17a of the seal l7.The two sections-15a, 15b are placed about the exposed lymph duct 12 as shown in FIG. 3, with the duct extending through the open ends 19. A resilient clamp 20 holds the two sections 15a, 15b in place.

Extending across the open portion of each semicylindrical member 15a, 15b is a pliable rubber or plastic membrane 22 held in place peripherally by the lip seal 17. This arrangement defines a closed interior chamber 23 between the shell 16 and the membrane 22. A port 24 is provided in each shell 16 through which the chamber 23 may be pressurized (FIG. 4) or evacuated (FIG. For cannulation, the facilitator is emplaced about the lymph duct 12 and a thread 25 is knotted about the proximal end thereof. A source-of pressure is attached to each port 24. The pressure source simply may comprise a medical syringe. Application of pressure through the ports 24 squeezes the membranes 22 toward each other. Air in the space 26 between the membranes 22 and the lymph duct 12 is forced out via the openings 19, the seal 17a in this region being sufficiently pliable to permit such venting. The membranes 22 will seat against each other in close surrounding relationship'with the duct 12 as shown in FIG. 4.

The duct 12 is massaged from the distal end to force additional lymph into the duct region within the facilitator l5. Simultaneously a slight vacuum is drawn through the ports 24. This may be accomplished using the same syringe that was used as a pressure source. The resultant reduced pressure condition in the chambers 23 aids dilation of the lymph duct 12 walls, as shown in FIG. 5. The cannulation needle 27 then readily may be inserted through the duct wall into the distended, lymph-filled lumen 12] of the duct 12 interior of the facilitator 15. The needle 27 is guided through the opening 19 at the distal end. The knot 25 is loosened, another knot 28 is tied at the distal end, and the opaque medium is injected via a flexible tube 29 and the needle 27 into the lymph duct 12 in the proximal direction.

Intending to claim all novel, useful and unobvious features shown or described, the applicant claims:

1. A device for facilitating cannulation of a lymph duct of a living being, comprising;

a rigid exterior shell configured to surround an elongate portion of said lymph duct, said shell being closed at each end except for orifices adapt to ac commodate said duct, said shell consisting of two 4 complementary shell members adapted to be clamped about said lymph duct to form a chamber within said shell and to contain said lymph duct portion,

a pair of pliable membranes within said shell, each pliable membrane being peripherally attached to a respective one of said shell members so as to define a respective confined space between said pliable membrane and said respective shell member, and

means for providing reduced pressure within each of said confined spaces so that said pliable membranes will be drawn toward said respective shell members, thereby reducing the pressure between said pliable membranes exterior to said duct to aid dilation thereof as excess lymph is massaged into said duct.

2. A device according to claim 1 further comprising a peripheral seal around the entire lip of each shell member, thereby providing a sealed region between said pliable members adapted to contain said lymph duct portion.

3. A device according to claim 1 wherein each of said shell members is generally semi-cylindrical, and wherein a resilient seal is provided about the duct accommodating orifices.

4. A process of lymph duct cannulation comprising the steps of;

placing a device according to claim 2 in surrounding relationship about a lymph duct,

blocking flow through said duct proximally of said device,

increasing the pressure within said confined spaces to force said pliable membranes into engagement with said lymph duct,

reducing the pressure within said confined spaces to cause said pliable membranes to move toward the respective shell members, thereby reducing pressure in said sealed region between said pliable members so as to aid dilation of said duct, while massaging lymph into the portion of said duct surrounded by said device from a region distal thereof,

inserting a cannulation needle into the lumen of said dilated duct portion, said needle being inserted through the device orifice, at the distal end of said duct, and

releasing said proximal blockage to permit injection in the proximal direction of material via said needle. 

1. A device for facilitating cannulation of a lymph duct of a living being, comprising; a rigid exterior shell configured to surround an elongate portion of said lymph duct, said shell being closed at each end except for orifices adapt to accommodate said duct, said shell consisting of two complementary shell members adapted to be clamped about said lymph duct to form a chamber within said shell and to contain said lymph duct portion, a pair of pliable membranes within said shell, each pliable membrane being peripherally attached to a respective one of said shell members so as to define a respective confined space between said pliable membrane and said respective shell member, and means for providing reduced pressure within each of said confined spaces so that said pliable membranes will be drawn toward said respective shell members, thereby reducing the pressure between said pliable membranes exterior to said duct to aid dilation thereof as excess lymph is massaged into said duct.
 2. A device according to claim 1 further comprising a peripheral seal around the entire lip of each shell member, thereby providing a sealed region between said pliable members adapted to contain said lymph duct portion.
 3. A device according to claim 1 wherein each of said shell members is generally semi-cylindrical, and wherein a resilient seal is provided about the duct accommodating orifices.
 4. A process of lymph duct cannulation comprising the steps of; placing a device according to claim 2 in surrounding relationship about a lymph duct, blocking flow through said duct proximally of said device, increasing the pressure within said confined spaces to force said pliable membranes into engagement with said lymph duct, reducing the pressure within said confined spaces to cause said pliable membranes to move toward the respective shell members, thereby reducing pressure in said sealed region between said pliable members so as to aid dilation of said duct, while massaging lymph into the portion of said duct surrounded by said device from a region distal thereof, inserting a cannulation needle into the lumen of said dilated duct portion, said needle being inserted through the device orifice, at the distal end of said duct, and releasing said proximal blockage to permit injection in the proximal direction of material via said needle. 